Provider Demographics
NPI:1184831885
Name:JANSE, CHRISTINE KELLY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KELLY
Last Name:JANSE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JANSE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:37463 COLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3232
Mailing Address - Country:US
Mailing Address - Phone:951-218-1118
Mailing Address - Fax:
Practice Address - Street 1:1361 S WINCHESTER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4328
Practice Address - Country:US
Practice Address - Phone:951-638-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9379083-3902106H00000X
CALMFT38996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist